plastic appeal letter help

Hey all - 6 year post op rny guy here - been recommended 2 times to go to plastic consult by wls doctor and both times have been denied. If anyone has had success in writing appeal letters to Bc/BS insurance PLEASE PLEASE PLEASE help would appreciate any and all advice -
THanks
Greg

Greg-
If you will write a rough draft so I know what your issues are and send me a copy of your denial I will try to help.

Red

Hi Greg!

What is the basis of their denial? Does your insurance have a complete exclusion for plastic surgery after weight loss?  Maybe it is a matter of wording using "reconstruction" instead of "cosmetic or plastic surgery".  Have you sent in pics, do you have rashes?  Do they require documentation of this?  is the surgeon asking for more than what is normally covered like a tummy tuck rather than a panni removal? Is he used to trying to get approval for these sorts of things?

We need more info to help you.. please provide so we can assist... hang in there.

Sorry to hear you were denied twice.  It's not easy sometimes.  A lot has to do with the documentation, how the plastic surgeon's office deals with the insurance company and there are times that you really have to fight for yourself and present your own best case for approval.

As others have said, you didn't disclose very much info.  If you could tell what you issues are, how they have been documented, what you submitted to BCBS, what diagnostic codes were used and what was their basis for denial, you'd most likely get a better response.

If you want to see another person's journey and get tips on what to include in an appeals letter, perhaps you can get some ideas from http://mygastricbypass.com/appeals.htm.

Good luck.